Eastern Oklahoma VA Health Care System

Women Veterans Program Newsletter
August 2024

Are Premenstrual Mood Changes Affecting You?

Some people have symptoms that only come before their menstrual bleeding. These are referred to as premenstrual symptoms.

Common symptoms include:

• Grouchiness
• Tiredness
• Soreness
• Easily stressed
• Feeling extra hungry
• Food cravings
• Bloating

When these symptoms are bothersome or get in the way of functioning, they could be a premenstrual condition.

The types of premenstrual conditions include:

• Premenstrual syndrome (PMS). Up to 4 symptoms that happen before menstrual periods and go away when menstrual bleeding starts.
• Premenstrual dysphoric disorder (PMDD). At least 5 premenstrual symptoms that cause distress and get in the way of functioning.
• Premenstrual exacerbation (PME). An ongoing medical or mental health problem that worsens before menstrual bleeding.  This can include mental health issues like depression, anxiety, bipolar disorder, and schizophrenia.  It can also include medical conditions like migraines, asthma, and seizures.

How premenstrual conditions can affect you

Untreated premenstrual symptoms can sometimes:

• Make it harder to manage stress
• Increase tension in relationships with others
• Get in the way of functioning your best at work
• Increase thoughts of suicide

Treatments for premenstrual mental health conditions for mild PMS symptoms, self-care can help, such as:

• Regular physical exercise
• Yoga
• Scheduling relaxing activities before your period and more challenging activities after your period

For PMDD, treatments include:

Certain antidepressant medicines. These can be taken daily, only during the two weeks before your period, or only when you start to feel symptoms.  Your doctor can help you figure out which medicine and dosing would work best for you.

Hormonal treatments. Most birth control pills don’t help PMDD, but one type does. This may be a good choice if you want birth control pills for other reasons. It can also help if you have difficulty with antidepressants.

For PME, treatment depends on which symptoms worsen before periods. For symptoms that respond to medicines, sometimes increasing the dose before the period starts can help. Menstruation can also affect levels of medicine in your body. Sometimes a doctor will check blood levels of medicine before and after menstrual periods to see if there are changes.

Talk therapy can help with any of these conditions. It doesn’t take away premenstrual symptoms, but it helps people find ways to cope with the symptoms and function better. Reach out to your VA Mental Health Provider or your Primary Care team for help.

Compassionate Care for Pregnancy Loss

VA Provides Compassionate Care for Pregnancy Loss

Every form of pregnancy loss comes with its own unique circumstances — all of which can impact your emotional and physical well-being.​ VA provides compassionate care for pregnancy loss to help you navigate your unique journey.

Understanding Pregnancy Loss

Pregnancy loss may occur in different ways and can be due to a variety of reasons. Pregnancy loss is the death of a fetus at any time during pregnancy. This can include miscarriage, stillbirth, or ectopic pregnancy.

Pregnancy loss is most common during the first trimester, and usually occurs for reasons you have no control over. It may result from genetic abnormalities, some maternal health conditions, and structural issues in the uterus or cervix. No matter what contributed to your pregnancy loss, your VA health care team offers care and support during this experience. We can help you understand why it happened and connect you to resources for support.

Pregnancy Loss and Your Health

Pregnancy loss can impact your emotional well-being, stirring up grief, sadness, guilt, anger, and other complex emotions. Physically, pregnancy loss may bring discomfort, bleeding, hormonal fluctuations, and other symptoms. interventions, such as procedures or medication, may also cause physical side effects. Pregnancy loss affects each person differently, so it’s crucial to allow yourself to experience your emotions and seek support and professional care as needed.

VA’s Pregnancy Loss Resources

We recognize that your pregnancy loss experience is unique. Your VA health care team will create a recovery plan tailored to your individual needs. This may include maternity, reproductive, and mental health care; counseling and support groups; chaplain services; family building and infertility support; and more. You have support from VA, including gynecologists, mental health care specialists, chaplains, support groups, Maternity Care Coordinators, primary care providers, and Women Veteran Program Managers.

You have support from VA, including:

• Gynecologists
• Mental health care specialists
• Chaplains
• Support groups
• Maternity care coordinators
• Primary care providers
• Women Veteran program managers

Call the Women Veterans Call Center at 1-855-VA-WOMEN to connect with pregnancy loss support and treatment, and visit the Women’s Health Pregnancy Loss page for more information. Additionally, your local Women Veterans Program Manager can assist you in accessing care. Her name is Michele Reeves and she can be reached at 918-577-4277 or the Maternity Care Coordinator, Makyla Clark 918-577-4240.

If you’re in crisis or concerned about a Veteran, contact the Veterans Crisis Line to receive 24/7 confidential support. You don’t have to be enrolled in VA benefits or health care to connect. Dial 988 then press 1, chat online, or text 838255.

Women Veterans Breast & Health Care Symposium

Eastern Oklahoma VA Women Veterans Program Presents
Women Veterans Breast & Health Care Symposium

Save the Date
October 24 | 1 to 3 p.m.
Ernest Childers VA Clinic, Tulsa

Come join your Women Veterans Program and learn the latest treatments for breast care and general health topics. We will have speakers from Medical Surgery, Oncology, Whole Health and general Primary Care.

Brain Health

Don't Let Your Brain Health Slip Your Mind

Women Veterans and their caretakers need to be sure their brain health doesn’t slip their minds and should know which symptoms to be on the lookout for in themselves and others. Some forgetfulness is normal, but these may be signs of something more serious, like dementia:

• Difficulty with complex tasks, like checkbook balancing
• Trouble recalling new information and events
• Unable to cope with unexpected events
• Getting lost in familiar places
• Trouble finding the right words or having a fluid conversation

If you or a woman Veteran you know is experiencing these symptoms, VA can help. Talk about your symptoms with your provider early, and we will work with you to create a plan that works for you. Your VA primary care or specialty care provider will perform a physical exam, order the necessary testing, and make referrals to determine if changes in your memory are due to dementia or something else. The earlier you bring it up, the better. The exam may include:

• Discussing your symptoms
• Discussing family history of dementia or Alzheimer's disease
• Reviewing all your medications
• Performing a physical exam, including heart and nerve testing, vision, and hearing
• Objective cognitive testing, such as a brief memory test
• Ordering lab tests or imaging tests
• Referring you to a specialist (like a neurologist) or social work if needed
• Referring you for a home safety evaluation

Order prosthetic items to meet your needs, like vision and hearing aids

If you have questions, Talk with your provider early about your symptoms so they can evaluate you and help you make a brain health plan. For more information on VA brain health services for women Veterans, visit: Memory Loss and Dementia | Women Veterans Health Care

Make Your Bones as Strong as Your Spirit

1 in 5 women over age 50 are affected by osteoporosis,
a disease that causes bones to weaken and break easily.
Talk to your VA health care provider about your risks and getting screened.

VA Women’s Health encourages all women Veterans to take action to prevent osteoporosis. One in five women over the age of 50 has osteoporosis, and most don’t know they have osteoporosis until they break a bone. Although osteoporosis is often associated with older women, women Veterans of all ages can make health and lifestyle changes to help prevent osteoporosis before it even begins.

Women Veterans might fall into into some unhealthy habits after leaving military service, such as smoking and not exercising as much as they would like to. These habits may lead to an increased risk of developing osteoporosis. Encourage women Veterans to talk with their VA health care providers about their unique risks for osteoporosis and discuss lifestyle changes that they could make to decrease their risk of developing osteoporosis. Women Veterans should be getting a DEXA scan at age 65 or younger if they have risk factors.

In addition to comprehensive primary care and women’s health services, VA offers the following resources to help women Veterans strengthen their bones:

VHA Women’s Health Osteoporosis Resources:
Information and resources to help women Veterans learn about the risk factors for osteoporosis and steps they can take to lower their risks.

VA Tobacco Cessation Resources:
VA offers a variety of resources to help Veterans quit tobacco use. Tobacco cessation is one way women Veterans can improve their bone and overall health.

VA Healthy Teaching Kitchen:
Eating more nutrient-dense food can help women Veterans reduce their risk of developing osteoporosis. VA offers virtual cooking classes to teach Veterans and their families healthy cooking skills.

She Wears the Boots Podcast on Osteoporosis:
Learn about osteoporosis in women Veterans from Dr. Radhika Narla, VA Endocrinologist. She helps Veterans understand the importance of preventing bone fractures and resources to help them strengthen their bones.

If you encounter women Veterans inquiring about bone health, encourage them to have a conversation with their VA health care provider to make a plan for necessary screenings and preventative steps. They can also call or text the Women Veterans Call Center at 1-855-829-6636. For more information on bone health and comprehensive health care services for women Veterans, visit: Women Veterans Health Care

Ask the Women's Health Medical Director!

Dr. Vanessa Meuniot

Dear Dr. Meuniot,
Why doesn't VA pay for hormone pellets to be inserted?

The VA will not pay for hormonal pellets because it is not a form of hormone therapy that is regulated and supported by the FDA. Hormonal pellets are compounded bioidentical hormones whose purity and safety are not governed and can pose additional risks for anyone using this form of hormone therapy. Compounded bioidentical hormones are advertised as being a safer, more effective, natural and individualized alternative to conventional hormone therapy. However, these claims remain unsupported by evidence-based research.

Bioidentical hormones are artificial hormones that are like the hormones produced by the human body. They are used as treatment for people whose own hormones are low or unbalanced. The FDA recommends against using hormone levels to guide the dosing of hormone therapy in women, as normal levels fluctuate day to day. Both hormone and nonhormone therapy are based on clinical response to treatment that is guided by your physician. The goal is to relieve symptoms with the lowest dose possible for the shortest amount of time. The VA does have hormonal therapies that are similar to bioidentical hormones on the formulary, but they are standardized formulas rather than compounded formulations that need to be bought through compounding pharmacies.

Not everyone is a candidate for hormone therapy as certain conditions can put you at greater risk like underlying blood clotting disorders, heart or cardiovascular disease, Breast cancer or previous stroke. Smoking also increases your risk of bad outcomes with hormone therapy.

If you are experiencing menopausal symptoms and want to discuss potential treatments that may help. We do have options available to help you at your local VA. Your Women Health teams will be more than happy to discuss your options with you!

Do you have a question for Dr. Meuniot regarding a health topic
or a general Women Veterans program question?

Email them to: Kellie.Zimmerman@va.gov

Meet Your Women's Health Clinical Pharmacist

Omaida Hernandez-Ray

I’m Omaida Hernandez-Ray, the dedicated clinical pharmacist for the Women’s Team. I joined the VA  in Tulsa, OK, 3 years ago. I graduated as a pharmacy school 9 years ago from the University of Houston.  As a clinical pharmacist for women veterans at the VA, my goal is to address the unique medication-related needs of this courageous and diverse group. I work with the healthcare team to prescribe and adjust medications for chronic disease states such as diabetes, hypertension, and hyperlipidemia. I also provide treatment for women-specific health conditions, such as emergency contraception and osteoporosis. My goal is to ensure safe and effective use of medications to support overall health. 

Your Eastern Oklahoma
VA Women Veterans Program Team

Michele Reeves, BSN, RN
Women Veterans Program Manager

Email: Michele.Reeves@va.gov
Phone: 918-577-4277

Makyla Clark, MSN, RN, CLC
Mammogram Navigator, Maternity Care Coordinator

Email: Makyla.Clark@va.gov
Phone: 918-577-4242